The present population-based study proposes to continue the examination of temporal trends in the incidence and survival rates of acute myocardial infarction (AMI) and out of hospital deaths due to coronary heart disease (CHD) in the setting of the Worcester, MA Standard Metropolitan Statistical Area (SMSA). The objectives of this study are to examine recent (1997 and 1999) as compared to prior (1975, 1978, 1981, 1984, 1986, 1988, 1990, 1991, 1993 and 1995) time trends in the annual attack rates of AMI and out of hospital CHD deaths, recent (1997 and 1999) as well as prior (1975-1995) changes over time in the in hospital and long term survival rates of AMI, and the relationship of these incidence and survival patterns of AMI to selected demographic, clinical and medical care factors. An additional objective of this study is to examine changes over time in the therapeutic management, diagnostic evaluation, and surgical workup of patients hospitalized with AMI as well as related issues of cost. To accomplish these objectives, the proposed study will be carried out in the 13 acute general hospitals in the Worcester, MA SMSA (1990 census count = 437,000). This study will utilize and extend previous approaches used in the conduct of this study. All new (incident) and recurrent episodes of definite AMI occurring among Worcester SMSA residents during calendar years 1997 and 1999 will be identified from discharge diagnostic printouts obtained from all metropolitan Worcester hospitals. The medical records of patients from the Worcester SMSA will be individually reviewed for validation purposes according to pre-established diagnostic criteria for AMI. Abstraction of the medical records of patients satisfying the diagnostic and geographic eligibility criteria will be carried out with the standardized recording of relevant data. A review of records for additional hospitalizations and a statewide and national search of death certificates will be carried out to examine the long-term survival status of discharged hospital patients from each of the proposed study years as well as those identified previously (1975-1995) through the year 2000. Death certificates of Worcester SMSA residents will be reviewed to identify cases of out of hospital deaths due to CHD occurring in 1997 and 1999 to determine temporal trends in these incidence rates. The results of this community-wide investigation may provide important insights from a twenty-four year vantage point about the role of primary and secondary preventive and therapeutic efforts to declining CHD mortality rates as it affects the population of a large representative and stable metropolitan area.